Provider Demographics
NPI:1326085150
Name:GESELL, ANTHONY W (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:W
Last Name:GESELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 WALLACE DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2797
Mailing Address - Country:US
Mailing Address - Phone:252-243-6386
Mailing Address - Fax:
Practice Address - Street 1:1811 FOREST HILLS RD W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3412
Practice Address - Country:US
Practice Address - Phone:252-243-7400
Practice Address - Fax:252-243-3291
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0777YOtherBCBS GROUP NUMBER
NC720777YMedicaid
NC720777YMedicaid